Provider Demographics
NPI:1053337972
Name:BRONNER, ABE ISAAC (DDS)
Entity type:Individual
Prefix:DR
First Name:ABE
Middle Name:ISAAC
Last Name:BRONNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4132
Mailing Address - Country:US
Mailing Address - Phone:718-382-0707
Mailing Address - Fax:718-375-9899
Practice Address - Street 1:622 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4132
Practice Address - Country:US
Practice Address - Phone:718-382-0707
Practice Address - Fax:718-375-9899
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2121079122300000X
NY042274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist